Impact of a VAD Optimization Clinic on Medication Utilization and Clinical Outcomes Following Left Ventricular Assist...

Guidance on the use of neurohormonal antagonists (NHA) following left ventricular assist device (LVAD) implantation remains scant despite studies showing that use may reduce morbidity and mortality. We evaluated the impact of a 12-week clinic designed to optimize NHA post-LVAD on medication use and outcomes. A multidisciplinary clinic enrolled patients' postimplantation. The clinic consisted of 6 visits and included medication optimization, nutrition, and pharmacy counseling. Not-enrolled patients served as the comparison group. A total of 44 patients completed the VAD optimization clinic, the comparison group included 71 patients. Enrolled patients averaged 56.1 (±11.4) years of age, 14 (31.8%) were female, 42 (95.5%) patients were HeartMate 3, and the average time to enrollment was 46 (±20) days postimplant. At the end of OPTIMIZE, there was a significant improvement in quadruple NHA utilization compared to controls. Fewer patients in our optimization group experienced recurrent (2 or more) hospitalizations within 6 months of LVAD implant compared to controls (p = 0.02). There was a trend toward reduction in right ventricle failure (p = 0.09) and 2-year mortality (p = 0.12) in those who completed the OPTIMIZE clinic. An optimization clinic post-LVAD improves NHA use and may lead to improved outcomes. Randomized, fully powered studies are needed to better understand how NHA optimization influences post-LVAD outcomes.